In emergency hypertension, could biomarkers change the guidelines?

• DOI: 10.1186/s12872-024-03785-3
• Publication Date: 2024-03-13T08:33:15Z
• Authors: Mohammad El Tahlawi; Scopus Mohamed Is...; Ahmed Eldamanhory; Ayman Khorshed; Salem M. Salem
• Keywords: Renal failure; Group B; 03 medical and health sciences; 0302 clinical medicine; Health Sciences; Diseases of the circulatory (Cardiovascular) system; Internal medicine; Angiology; Target blood pressure; Goal-Directed Therapy; Target organ damage; Optimization of Perioperative Fluid Therapy; Research; Incidence (geometry); Physics; Hemodynamic Monitoring; Troponin Levels; Gastroenterology; Management of Hypertension and Cardiovascular Risk Factors; Optics; Biomarker; Cardiac surgery; Perioperative Cardiac Risk Assessment and Management; Troponin; Prospective cohort study; Nephrology; RC666-701; Creatinine; Hypertension; Emergency hypertension; Blood pressure; Medicine; Surgery; Cardiology and Cardiovascular Medicine; Renal function

Abstract Background Hypertension may cause target organ damage (TOD). Target blood pressure (BP) management may not be appropriate in some conditions.

Aim We aim to assess the impact of targeted BP management in severe hypertension on renal TOD.

Patients & methods This is a prospective cohort study involving patients admitted due to severe hypertension (BP > 180/120) associated with any symptoms. The study involved patients referred to the ICU in our tertiary center during the period between August 2017 and February 2018. All patients underwent target BP treatment according to recent guidelines. Hs-Troponin T (hs-TNT) and serum creatinine (s.creat) were measured in all patients on admission and 24 h later. Patients were divided into Group A (with initial normal hs-TNT) and Group B (with initial high hs-TNT). The main outcome was in-hospital renal-related morbidity (including renal failure).

Results Four hundred seventy consecutive patients with hypertensive crises were involved in the study. Group B had a significantly higher incidence of in-hospital mortality (4 patients) and renal TOD (acute renal dysfunction) than Group A (P value = 0.001 and 0.000 respectively). There was a significant difference between initial s.creat on admission and follow-up s.creat values in Group B with significant elevation of their s.creat on the following 24 h (P = 0.002), while this difference is insignificant in Group A (P = 0.34). There was a significant positive correlation between hs-TNT and the follow-up s.creat (P = 0.004).

Conclusion In severe HTN, hs-TNT may be elevated due to marked afterload. Patients with severe HTN and high hs-TNT have higher s.creat values, which are associated with an increased risk of renal failure and in-hospital mortality if their BP decreases acutely to the guideline-target BP. Using biomarkers during the management of emergency HTN should be considered before following clinical guidelines. However, our findings do underscore the potential utility of hs-TNT as an indicator for risk stratification in patients with severe or emergency HTN.